Healthcare Provider Details

I. General information

NPI: 1841009750
Provider Name (Legal Business Name): JAMISON ANDREW BLENKER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 E 4TH AVE
POST FALLS ID
83854-4042
US

IV. Provider business mailing address

1004 E 4TH AVE
POST FALLS ID
83854-4042
US

V. Phone/Fax

Practice location:
  • Phone: 208-571-4868
  • Fax:
Mailing address:
  • Phone: 208-571-4868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number9071546
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP70106770
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: